Job Description

WNS HealthHelp (A Capgemini Company) is seeking Board-Certified Orthopedic Surgeons licensed in the state of Oregon specialized in musculoskeletal conditions and joint procedures (shoulder, hip, and knee) for high-impact case review roles on Contract. At WNS HealthHelp (A Capgemini Company), our mission is to collaborate with payors and providers to improve patient safety and deliver quality care through an evidence-based, educative, and collaborative model, focused on improving outcomes and reducing healthcare costs. We’re revolutionizing healthcare delivery by ensuring patients receive the most appropriate, cost-effective care while supporting healthcare providers in their decision-making process. Role Overview As a Specialty Physician Reviewer, you’ll leverage your clinical expertise to make significant impact on patient care and healthcare efficiency. In this role, you will: Conduct thorough reviews of complex musculoskeletal orthopedic cases, with emphasis on shoulder, hip, and knee procedures Provide valuable peer-to-peer consultations with treating physicians, fostering collaborative relationships and knowledge sharing within the medical community Ensure adherence to evidence-based guidelines and best practices, staying at the forefront of medical advancements in spine surgery Contribute to the continuous improvement of our utilization management processes, helping shape the future of healthcare delivery Exercise your clinical judgement to render well-reasoned decisions, based on evidence-based clinical criteria, including crafting comprehensive denial rationales when necessary. Requirements MD or DO degree from an accredited school of medicine Current, active, unrestricted license to practice medicine in the Oregon state Board certification in one of the following: ABMS/AOA board certified orthopedic surgeon Active practice in musculoskeletal orthopedic surgery with focus on shoulder, hip, and knee procedures. Orthopedic spine surgeon or orthopedic sports medicine preferred Meets HealthHelp credentialing requirements Ability to make outbound calls to providers as part of the case review process Ability to collaborate with HealthHelp nursing and administration staff members Excellent negotiation, leadership, and communication skills Proficiency in using digital platforms for case review and communication Preferred Qualifications Utilization Management case review experience Academic affiliation Participation in Interstate Medical Licensure Compact Experience or familiarity with principles and procedures of utilization management in managed care Ability to support flexible working hours Experience and familiarity with government programs Demonstrated ability to follow evidence-based practices in reviewing cases for medical appropriateness Commitment to an educational model in discussing and sharing clinical evidence with peers Experience with joint replacement and reconstructive procedures Expertise in both primary and revision joint surgery Track record of applying evidence-based approaches to musculoskeletal conditions Job Type - Remote / Contract WNS HealthHelp (A Capgemini Company) provides cutting-edge technology to streamline the review process, including our proprietary HIPAA – compliant portal and Physician App, ensuring efficiency and ease of use for our specialists. WNS HealthHelp (A Capgemini Company) is an Equal Opportunity Employer. At WNS HealthHelp, we celebrate diversity and are committed to creating an inclusive environment that extends to our suppliers and vendors. All qualified Independent Contractors will receive consideration without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other status protected under federal, state, or local law.

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